Female urethral condyloma acuminata mimicking urethral caruncle.

Condyloma acuminata are epidermal lesions caused by the human papillomavirus (HPV) most commonly affecting the anogenital region. Urethral involvement is uncommon, and may mimic other urethral lesions. In this case report, a 62-year-old patient presents with what was believed to be a urethral caruncle and underwent successful resection with the final pathologic diagnosis of urethral condyloma. The clinical features and diagnosis are reviewed. This condition should be considered in the differential diagnosis of females with known HPV or those who are deemed higher risk with unprotected sexual encounters.

Transvaginal Mesh Placement and the Instructions for Use: A Survey of North American Urologists.

INTRODUCTION: Since the issue of the FDA (Food and Drug Administration) Public Health Notification in 2008 regarding complications associated with the use of transvaginal surgical mesh for pelvic organ prolapse and stress urinary incontinence, multimillion dollar litigation has been brought against the companies that have manufactured these products. One component of the litigation has focused on risk information provided in the Instructions for Use document provided with each mesh kit. In this study we evaluated the types of urologists using transvaginal mesh kits and their use of the Instructions for Use provided with each mesh kit. METHODS: A 14-question survey was e-mailed to all urologists registered with 7 of the 8 geographic sections of the American Urological Association in 2016. The survey inquired about the use of transvaginal mesh kits for prolapse and incontinence as well as how often, if ever, the urologist had read the Instructions for Use. RESULTS: Overall there were 314 respondents. The majority (79.3%) identified as general urologists and 12.7% identified as Female Pelvic Medicine and Reconstructive Surgery trained urologists. Of the respondents who reported having placed mid urethral slings and/or a mesh prolapse repair kit, 36.9% and 23.1%, respectively, had never read the Instructions for Use. Of those providers who had read the Instructions for Use the most common frequency was once before the first placement. CONCLUSIONS: The pertinent role of the Instructions for Use in mesh related litigation stands in contrast to our finding that many surgeons who use these kits read the Instructions for Use infrequently, if ever.

Effects of an outreach and internal navigation program on breast cancer diagnosis in an urban cancer center with a large African-American population.

BACKGROUND: Compared with white women, African-American (AA) women who are diagnosed with breast cancer experience an excess in mortality. To improve outcomes, the authors implemented community education and outreach initiatives in their cancer center, at affiliated primary care sites, and in the surrounding communities. They then assessed the effectiveness of these outreach initiatives and internal patient navigation on stage of diagnosis. METHODS: This cross-sectional study was an analysis of all women with breast cancer who were diagnosed and/or treated in the years from 2001 through 2004. The outreach initiatives were implemented in 2001; 125 trained Community Health Advocates (CHAs) provided educational programs to the community, and Patient Navigators communicated directly with patients to encourage screening, diagnostic procedures, and treatment. RESULTS: In total, 487 patients were diagnosed/treated from 2001 through 2004. Since 2001, there were 1148 community interventions by CHAs with an estimated program attendance of >10,000 participants. In the interval from 2001 through 2004, the proportion of stage 0 (in situ) breast cancers increased from 12.4% (n = 14) to 25.8% (n = 33; P < .005), and there was a decline in stage IV invasive breast cancers from 16.8% (n = 19) to 9.4% (n = 12; P < .05). CONCLUSIONS: The outreach initiatives and internal patient navigation appear to have improved stage at diagnosis. To determine whether specific patients presented earlier as a result of specific community outreach initiatives, prospective work is underway to measure the effects of these interventions on potential stage migration. Similarly, prospective data are being collected to determine whether Patient Navigators influence treatment and appointment adherence as well as the underlying reasons for barriers to specific interventions in this underserved minority population.